Incidence Of Agranulocytosis Research Articles

Dipyrone for acute primary headaches

Introduction: Headaches commonly affect working-age people. Dipyrone is largely used in many countries. Objectives: To determine effectiveness/safety of dipyrone for adults with acute primary headaches. Method: Double blind randomized controlled trials systematic review. Dichotomous data were expressed as relative risks and risk differences, and continuous data as weighted mean differences. If possible, numbers-needed-to-treat were calculated. Results: Four studies were included (636 subjects). Meta-analysis was possible for one outcome, favouring dipyrone. Regarding episodic tension-type headache and migraine, individual studies data showed dipyrone statistically significant beneficial effect. No severe adverse events were reported. There was no statistically significant difference between dipyrone and placebo regarding mild to moderate adverse events. Conclusion: Dipyrone is effective in migraine and episodic tension-type headache. Conclusions about its safety and agranulocytosis can not be drawn probably due to the relatively small sample. If the results of a recent study, which is related to the incidence of agranulocytosis in Latin America, do not clarify the question, data from observational studies on dipyrone side effects should be searched to determine its safety.

Agranulocytosis in Bangkok, Thailand: a predominantly drug-induced disease with an unusually low incidence. Aplastic Anemia Study Group.

Agranulocytosis, a syndrome characterized by a marked reduction in circulating granulocytes, is strongly associated with medical drug use in Europe and the United States. Unregulated use of common pharmaceutical agents in developing countries has been suspected of causing large numbers of cases of agranulocytosis and deaths, especially among children. To elucidate the incidence and etiology of agranulocytosis in Thailand, a population-based case-control study of symptomatic agranulocytosis that resulted in hospital admission was conducted in Bangkok from 1990 to 1994. An attempt was also made to study the disease in Khonkaen (in northeastern Thailand) and Songkla (in southern Thailand), but there were insufficient cases in the latter regions, and the analysis was confined to subjects from Bangkok. In that region, the overall incidence of agranulocytosis was 0.8 per million per year; there were no deaths. As expected, the incidence was higher in females (0.9 per million), and it increased with age (4.3 per million beyond age 60). Among 25 cases and 529 controls the relative risk estimate for a combined category of all suspect drugs was 9.2 (95% confidence interval = 3.9-21), and the proportion of cases that could be attributed to drug use was 68%. For individual drugs and drug classes the data were sparse; within these limitations, the strongest association appeared to be with antithyroid drugs. One case and three controls were exposed to dipyrone, a drug known to cause agranulocytosis; with such scanty data the risk could not be evaluated. Exposure to pesticides or solvents was not associated with an increased risk. This is the first formal epidemiologic study of agranulocytosis in a developing country. As in the West, most cases are attributable to medical drug use. However, the incidence of agranulocytosis in Bangkok, and apparently, in Thailand as a whole, is unusually low, and the disease does not pose a public health risk.

Olanzapine treatment after clozapine induced agranulocytosis

Clozapine is an atypical antipsychotic with a significant incidence of agranulocytosis. Olanzapine resembles clozapine structurally; however, it lacks a halogen, which has been implicated in agranulocytosis. Both agents have a similar pharmacological profile. We therefore studied olanzapine in patients with a history of clozapine-induced agranulocytosis. Two patients with severe clozapine-induced agranulocytosis and no benefit from classic neuroleptics were treated with olanzapine with informed consent. Psychosis improved in both patients and no hematological changes were noted. Olanzapine may be a safe treatment alternative in patients with a history of clozapine agranulocytosis. Copyright © 1998 John Wiley & Sons, Ltd.

Clozapine treatment in Australia: a review of haematological monitoring.

Clozapine is an atypical antipsychotic drug indicated for patients with schizophrenia in whom traditional antipsychotic drugs (such as haloperidol or the phenothiazines) are ineffective, or in those who experience intolerable adverse effects. Clozapine treatment may be complicated by the development of life-threatening agranulocytosis, so regular haematological monitoring is required. To determine the incidence of clozapine-induced agranulocytosis in Australia and the importance of monitoring white blood cell counts in patients treated with clozapine. Review of haematological monitoring for the first three years (June 1993-July 1996) of operation of the Australian Clozaril (clozapine; Novartis Australia) Patient Monitoring System (CPMS) central database. In the 4061 patients prospectively monitored by the CPMS, the incidence of agranulocytosis, neutropenia and leukopenia combined was 2.6% (n = 104); the incidence of agranulocytosis was 0.9% (n = 37). So far there have been no deaths in Australia from the complications of clozapine-induced agranulocytosis. The incidence of agranulocytosis and neutropenia associated with clozapine use in Australia is similar to that in the rest of the world. Monitoring the white blood cell counts of patients being treated with clozapine ensures minimal risk to patients who develop agranulocytosis.

Vesnarinone-induced WBC disorders in Japan.

Vesnarinone is a new oral inotropic agent that augments myocardial contractility with little effect on heart rate or myocardial oxygen consumption. In Japan, vesnarinone was approved in June 1990 and first marketed in September 1990. Although the efficacy of vesnarinone has been confirmed, WBC disorders, which are principal adverse events associated with the use of vesnarinone, were found after marketing was begun in Japan. This survey was carried out to estimate the incidence of WBC disorders, the predominant periods in which these adverse events develop, and the effects of risk factors in the cohort of patients who have been administered vesnarinone since its market release in Japan. Data were available for 14,921 patients who took vesnarinone at least once during the period from 1 March 1991, through 28 February 1994. Vesnarinone-induced agranulocytosis, which is usually evidenced by a sharp decrease in granulocyte count, was seen in 0.25% of the patients. The cumulative incidence of agranulocytosis was 0.34% at 12 weeks. The predominant period of development was estimated to be the first 4 months after initiation of therapy, with the rate peaking in the second month. The risk of WBC disorders was higher among females.

Orally active iron chelators in the treatment of iron overload.

Data from several trials have provided evidence for the efficacy of deferiprone in the treatment of iron overload in thalassemia major. Deferiprone has now been shown to induce sustained decreases in tissue iron to concentrations that are associated with survival free of the complications of iron overload in deferoxamine-treated patients. Despite this evidence of efficacy, the risk of agranulocytosis mandates a careful evaluation of the risk of this drug in patients willing and able to use deferoxamine. The incidence of agranulocytosis associated with deferiprone is under study in a prospective multicenter trial in Canada, Italy, and the United States, under corporate sponsorship by Apotex Research in Canada. The results of this study should determine the risk associated with the use of this agent and may provide the data required for a US Food and Drug Administration decision regarding licensing of this agent for the treatment of iron overload, a goal supported by investigators worldwide.

The Incidence of Agranulocytosis During Treatment of Dermatitis Herpetiformis With Dapsone as Reported in Sweden, 1972 Through 1988

During the 17-year period 1972 through 1988, a total of seven cases of agranulocytosis associated with the use of dapsone for the treatment of dermatitis herpetiformis were reported in Sweden. The median age of the patients involved was 61 years; three of them were male. The median duration of dapsone treatment was 7 weeks and the daily prescribed dose was 100 mg. Based on sales and prescription data, the crude relative risk of agranulocytosis during dapsone treatment of dermatitis herpetiformis was 50, and the total risk was one case per 3000 patient years of exposure to dapsone. In relation to the number of new cases of dermatitis herpetiformis, agranulocytosis was estimated to develop in 1 of 240 to 425 patients receiving dapsone therapy. Patients should be instructed to seek medical care immediately in case of fever.

The incidence of agranulocytosis during treatment of dermatitis herpetiformis with dapsone as reported in Sweden, 1972 through 1988

The incidence of agranulocytosis during treatment of dermatitis herpetiformis with dapsone as reported in Sweden, 1972 through 1988

The incidence of dipyrone-induced agranulocytosis in Greece during 1975.

A retrospective epidemiological study was conducted in Greece during 1975 to assess the incidence of agranulocytosis following treatment with dipyrone. Twenty-four cases of agranulocytosis were reported, of which fifteen were possibly associated with medication. If all fifteen cases are attributed to dipyrone, the incidence of agranulocytosis following treatment with this drug lies between one case in every 133,000 and one case in every 466,000 treatments.

Drugs and acute agranulocytosis: analysis of previous drug intake in 42 patients (author's transl)

An exact account of previous drug intake was obtained in 42 patients with acute agranulocytosis. Because of the multiplicity of administered drugs, often in the form of multiple-drug preparations, it was possible in only a minority of cases to ascribe with any degree of certainty a causative role to any particular drug. But outstanding as possible causes were thyrostatic drugs and pyrazolone. But no conclusion could be drawn as to the incidence of agranulocytosis with regard to these drugs because of the absence of data on the frequency that they are prescribed and the unknown number of fatal cases of agranulocytosis. The results indicate that multiple drug treatment and in particular the unnecessary prescribing of multiple-drug preparations makes it difficult to ascertain side-effects of drugs. They once again point to the need of frequent checks of white cell count in the drug treatment of pyrexial diseases.

TRANSIENT GRANULOCYTOPENIA ASSOCIATED WITH ADMINISTRATION OF A NEW THIORIDAZINE DERIVATIVE: TPS-23

A case of transient granulocytopenia is reported during the seventh week of administration of TPS-23, a thioridazine derivative, in a patient who had received no medication for 59 days prior to the initiation of this new psychopharmacologic compound. However, the one occurrence of this serious toxic effect should not deter further evaluation of this compound which has obvious anti-psychotic and anti-depressant activity(1), unless additional evidence by other investigators reveals that the incidence of agranulocytosis is significantly greater with TPS-23 than it is with other phenothiazines.

Uneventful Trifluoperazine (Stelazine) Therapy After Previous Granulocytic Depression

There are many reports referring to incidence of agranulocytosis in patients receiving phenothiazines. This and the potential hepatotoxic effect of this group of drugs have been the greatest drawback in their usage.

Butazolidin in the treatment of non-articular rheumatic disorders.

Summary A second series of one hundred cases treated with Butazolidin has been reported.This series has been compared with the first one hundred cases and shows improved results.Certain precautions must be observed in prescribing the drug.Very few toxic effects are encountered if these precautions are taken, and if only short courses of treatment are given.From the literature, it appears that the incidence of agranulocytosis developing is approximately .00025%.Its effect is dramatic in cases of acute gout and coccygodynia.For general practice, the value of this drug lies in its almost specific effect on the attack of acute rheumatic fibrositis, relief being obtained frequently within 48 hours.

Agranulocytosis in Kala-azar and use of adrenalin

1. 1. The methods of diagnosis of kala-azar are reviewed. Emphasis is laid upon the simplicity and reliability of glandular puncture. 2. 2. The incidence of agranulocytosis in kala-azar is very small, and the literature on the subject is reviewed. 3. 3. The treatment of agranulocytosis is discussed, with special reference to the value of adrenalin. 4. 4. A case of kala-azar occurring in this country is described in detail, together with the treatment of the resulting agranulocytosis.